Pemberton's sign

The Pemberton's sign is a physical examination tool used to demonstrate the presence of latent pressure in the thoracic inlet.^[1] The sign is named after Hugh Pemberton, who characterized it in 1946.^[2]

The Pemberton maneuver is achieved by having the patient elevate both arms (usually 180 degrees anterior flexion at the shoulder) until the forearms touch the sides of the face. A positive Pemberton's sign is marked by the presence of facial congestion and cyanosis, as well as respiratory distress after approximately one minute.^[2]

A positive Pemberton's sign is indicative of superior vena cava syndrome (SVC), commonly the result of a mass in the mediastinum. Although the sign is most commonly described in patients with substernal goiters where the goiter "corks off" the thoracic inlet,^[3] the maneuver is potentially useful in any patient with adenopathy, tumor, or fibrosis involving the mediastinum. SVC syndrome has been observed as a result of diffuse mediastinal lymphadenopathy of various pathologies such as cystic fibrosis^[4] and Castleman’s disease.^[5] Park et al. reported enlarged cervical lymph nodes associated with hemophagocytic lymphohistiocytosis as the cause of internal jugular vein compression, which presented clinically similar to SVC syndrome.^[6]

• Abu-Shama Y and Cuny T. Pemberton’s Sign in a Patient with a Goiter. N Engl J Med. 2018;378:e31. doi:10.1056/NEJMicm1712263. A short case illustrating Pemberton's sign, with images and a video.